Department of Otorhinolaryngology, Yonsei University, College of Medicine, Seoul, South Korea.
Oral Oncol. 2009 Dec;45(12):1063-6. doi: 10.1016/j.oraloncology.2009.07.017. Epub 2009 Aug 29.
To evaluate treatment outcomes and the role of primary definitive surgery for T(1-2), clinically N(0) oropharyngeal squamous cell carcinoma (OPSCC) patients, we performed a retrospective analysis of 46 consecutive cases treated primarily by surgery and/or postoperative radiotherapy at Yonsei University between May 1992 and December 2006. Twelve patients were T(1) and 34 were T(2). The most common location was the tonsil (54%), followed by the soft palate (19%), the base of the tongue (BOT) (15%) and the posterior wall (12%). Occult lymph node metastasis was noted in 12 cases (26%). Seventeen patients (37%) received adjuvant radiotherapy. The 5-year disease-specific survival rate (DSSR) was 83%: 100% for clinical stage I (T(1)N(0)) and 74% for clinical stage II (T(2)N(0)). The 5-year DSSR of patients with surgery alone was 86%. Thirteen of 14 patients (93%) treated with conservative surgery alone without mandible-splitting or adjuvant radiotherapy attained disease-free status. In addition, 25 of 40 patients (63%) with disease-free status were treated with surgery alone. Almost 30% of all patients may be candidates for adjuvant chemotherapy through histopathologic analysis according to the National Comprehensive Cancer Network (2007) guidelines. The results of the present study demonstrate excellent oncologic outcomes with primary surgery for the treatment of early-stage OPSCC and suggest that surgery offers the best opportunity to identify patients in whom adjuvant radio- or chemotherapy may be most appropriately applied.
为了评估 T(1-2)、临床 N(0)口咽鳞状细胞癌 (OPSCC) 患者的初始确定性手术治疗效果和作用，我们对延世大学 1992 年 5 月至 2006 年 12 月期间主要通过手术和/或术后放疗治疗的 46 例连续病例进行了回顾性分析。12 例患者为 T(1)，34 例患者为 T(2)。最常见的部位是扁桃体（54%），其次是软腭（19%）、舌根（BOT）（15%）和后咽壁（12%）。12 例（26%）患者存在隐匿性淋巴结转移。17 例（37%）患者接受了辅助放疗。5 年疾病特异性生存率（DSSR）为 83%：I 期（T(1)N(0)）患者为 100%，II 期（T(2)N(0)）患者为 74%。单纯手术患者的 5 年 DSSR 为 86%。14 例单纯保守性手术且不劈开下颌骨或不接受辅助放疗的患者中，13 例（93%）达到无疾病状态。此外，40 例无疾病状态的患者中有 25 例（63%）仅接受手术治疗。根据美国国家综合癌症网络（2007）指南，将近 30%的所有患者可能有资格通过组织病理学分析接受辅助化疗。本研究结果表明，对于早期 OPSCC，初始手术治疗具有良好的肿瘤学效果，并表明手术为识别最适合应用辅助放化疗的患者提供了最佳机会。
